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BMJ Open Apr 2023We aimed to summarise the prevalence of atypical pathogens in patients with severe pneumonia to understand the prevalence of severe pneumonia caused by atypical... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
We aimed to summarise the prevalence of atypical pathogens in patients with severe pneumonia to understand the prevalence of severe pneumonia caused by atypical pathogens, improve clinical decision-making and guide antibiotic use.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Embase, Web of Science and Cochrane Library were searched through November 2022.
ELIGIBILITY CRITERIA
English language studies enrolled consecutive cases of patients diagnosed with severe pneumonia, with complete aetiological analysis.
DATA EXTRACTION AND SYNTHESIS
We conducted literature retrieval on PubMed, Embase, Web of Science and The Cochrane Library to estimate the prevalence of , and in patients with severe pneumonia. After double arcsine transformation of the data, a random-effects model was used for meta-analyses to calculate the pooled prevalence of each pathogen. Meta-regression analysis was also used to explore whether the region, different diagnostic method, study population, pneumonia categories or sample size were potential sources of heterogeneity.
RESULTS
We included 75 eligible studies with 18 379 cases of severe pneumonia. The overall prevalence of atypical pneumonia is 8.1% (95% CI 6.3% to 10.1%) In patients with severe pneumonia, the pooled estimated prevalence of , and was 1.8% (95% CI 1.0% to 2.9%), 2.8% (95% CI 1.7% to 4.3%) and 4.0% (95% CI 2.8% to 5.3%), respectively. We noted significant heterogeneity in all pooled assessments. Meta-regression showed that the pneumonia category potentially influenced the prevalence rate of . The mean age and the diagnostic method of pathogens were likely moderators for the prevalence of and , and contribute to the heterogeneity of their prevalence.
CONCLUSIONS
In severe pneumonia, atypical pathogens are notable causes, especially . The diagnostic method, regional difference, sample size and other factors contribute to the heterogeneity of prevalence. The estimated prevalence and relative heterogeneity factors can help with microbiological screening, clinical treatment and future research planning.
PROSPERO REGISTRATION NUMBER
CRD42022373950.
Topics: Humans; Pneumonia, Bacterial; Prevalence; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Legionella; Chlamydia
PubMed: 37041056
DOI: 10.1136/bmjopen-2022-066721 -
BMC Infectious Diseases Mar 2023Ureaplasma urealyticum is the most prevalent genital mycoplasma isolated from the urogenital tract of females, but there is no unified treatment plan. This study aimed... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ureaplasma urealyticum is the most prevalent genital mycoplasma isolated from the urogenital tract of females, but there is no unified treatment plan. This study aimed to evaluate the efficacy of azithromycin in treating Ureaplasma urealyticum.
METHODS
From the earliest to June 2022, published randomized controlled trials (RCTs) on azithromycin treatment of Ureaplasma urealyticum were retrieved by searching PubMed, Embase, Cochrane Library, and Web of Science. Two reviewers independently extracted the data. We utilized the Cochrane risk-of-bias assessment technique to assess the quality of included RCTs. The data were analyzed using the R language (version 4.0.4) software.
RESULTS
Seven RCTs were finally included, involving 512 participants (240 in the experimental group, 272 in the control group). The experimental group was treated with azithromycin monotherapy, while the control group was treated with doxycycline or a placebo. Meta-analysis results suggested that azithromycin has a comparable therapeutic effect on Ureaplasma urealyticum in comparison to that of controls (risk ratio [RR] = 1.03, 95% confidence interval [CI] 0.94-1.12). Subgroup analysis showed that the dose and duration of azithromycin may don't affect its efficacy.
CONCLUSION
Regarding the meta-analysis that we performed based on existing clinical studies, azithromycin is quite effective in treating Ureaplasma urealyticum.
Topics: Female; Humans; Azithromycin; Ureaplasma urealyticum; Doxycycline; Ureaplasma Infections; Anti-Bacterial Agents; Ureaplasma
PubMed: 36927441
DOI: 10.1186/s12879-023-08102-5 -
Sexually Transmitted Infections Aug 2023To summarise the prevalence of (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To summarise the prevalence of (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users.
METHODS
We searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULTS
A total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate.
CONCLUSION
We observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population.
PROSPERO REGISTRATION NUMBER
CRD42022310597.
Topics: Mycoplasma genitalium; Pre-Exposure Prophylaxis; HIV Infections; Humans; Mycoplasma Infections; Drug Resistance, Bacterial; Macrolides; Anti-Bacterial Agents; Prevalence
PubMed: 36759179
DOI: 10.1136/sextrans-2022-055687 -
The Ocular Surface Apr 2023Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a relatively newly identified clinical entity which is characterized by mucocutaneous manifestations in the... (Review)
Review
Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a relatively newly identified clinical entity which is characterized by mucocutaneous manifestations in the setting of Mycoplasma infection. Though a clinically distinct disease, MIRM exists on a diagnostic continuum with entities including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and the recently described reactive infectious mucocutaneous eruption (RIME). In this systematic review, we discuss published findings on the epidemiology, clinical manifestations, diagnosis, and management of MIRM, with an emphasis on ocular disease. Lastly, we discuss some of the most recent developments and challenges in characterizing MIRM with respect to the related diagnosis of RIME.
Topics: Humans; Mucositis; Mycoplasma pneumoniae; Stevens-Johnson Syndrome; Eye; Exanthema
PubMed: 36396020
DOI: 10.1016/j.jtos.2022.11.007 -
Transplant Infectious Disease : An... Dec 2022Hyperammonemia syndrome (HS) is a rare post-transplant complication associated with high morbidity and mortality. Its incidence appears to be higher in lung transplant... (Review)
Review
BACKGROUND
Hyperammonemia syndrome (HS) is a rare post-transplant complication associated with high morbidity and mortality. Its incidence appears to be higher in lung transplant recipients and its pathophysiology is not well understood. In addition to underlying metabolic abnormalities, it is postulated that HS may be associated with Ureaplasma or Mycoplasma spp. lung infections. Management of this condition is not standardized and may include preemptive antimicrobials, renal replacement, nitrogen scavenging, and bowel decontamination therapies, as well as dietary modifications.
METHODS
In this case series, we describe seven HS cases, five of whom had metabolic deficiencies ruled out. In addition, a literature review was performed by searching PubMed following PRISMA-P guidelines. Articles containing the terms "hyperammonemia" and "lung" were reviewed from 1 January 1997 to 31 October 2021.
RESULTS
All HS cases described in our center had positive airway samples for Mycoplasmataceae, neurologic abnormalities and high ammonia levels post-transplant. Mortality in our group (57%) was similar to that published in previous cases. The literature review supported that HS is an early complication post-transplant, associated with Ureaplasma spp. and Mycoplasma hominis infections and of worse prognosis in patients presenting cerebral edema and seizures.
CONCLUSION
This review highlights the need for rapid testing for Ureaplasma spp. and M. hominis after lung transplant, as well as the necessity for future studies to explore potential therapies that may improve outcomes in these patients.
Topics: Humans; Meta-Analysis as Topic; Lung Transplantation; Hyperammonemia; Ureaplasma
PubMed: 36039822
DOI: 10.1111/tid.13940 -
BMJ Open Aug 2022and (genital mycoplasmas) commonly colonise the urogenital tract in pregnant women. This systematic review aims to investigate their role in adverse pregnancy and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
and (genital mycoplasmas) commonly colonise the urogenital tract in pregnant women. This systematic review aims to investigate their role in adverse pregnancy and birth outcomes, alone or in combination with bacterial vaginosis (BV).
METHODS
We searched Embase, Medline and CINAHL databases from January 1971 to February 2021. Eligible studies tested for any of the three genital mycoplasmas during pregnancy and reported on the primary outcome, preterm birth (PTB) and/or secondary outcomes low birth weight (LBW), premature rupture of membranes (PROM), spontaneous abortion (SA) and/or perinatal or neonatal death (PND).Two reviewers independently screened titles and abstracts, read potentially eligible full texts and extracted data. Two reviewers independently assessed risks of bias using published checklists. Random effects meta-analysis was used to estimate summary ORs (with 95% CIs and prediction intervals). Multivariable and stratified analyses were synthesised descriptively.
RESULTS
Of 57/1194 included studies, 39 were from high-income countries. In meta-analysis of unadjusted ORs, was associated with PTB (OR 1.87, 95% CI 1.49 to 2.34), PROM, LBW and PND but not SA. was associated with PTB (OR 1.84, 95% CI 1.34 to 2.55), PROM, LBW, SA and PND. was associated with PTB (1.60, 95% CI 1.12 to 2.30), PROM and SA. Nine of 57 studies reported any multivariable analysis. In two studies, analyses stratified by BV status showed that and were more strongly associated with PTB in the presence than in the absence of BV. The most frequent source of bias was a failure to control for confounding.
CONCLUSIONS
The currently available literature does not allow conclusions about the role of mycoplasmas in adverse pregnancy and birth outcomes, alone or with coexisting BV. Future studies that consider genital mycoplasmas in the context of the vaginal microbiome are needed.
PROSPERO REGISTRATION NUMBER
CRD42016050962.
Topics: Female; Humans; Infant, Newborn; Mycoplasma Infections; Mycoplasma hominis; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Ureaplasma; Ureaplasma urealyticum; Vaginosis, Bacterial
PubMed: 36028274
DOI: 10.1136/bmjopen-2022-062990 -
Journal of Immunology Research 2022Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia (CAP) in children. infection is usually regarded as a self-limiting disease, but in some... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia (CAP) in children. infection is usually regarded as a self-limiting disease, but in some special cases, it can also develop into refractory Mycoplasma pneumoniae pneumonia (RMPP). The aim of this study is to analyze the clinical characteristics of CRP (C-reactive protein), LDH (lactate dehydrogenase), ESR (erythrocyte sedimentation rate), , neutrophils (%), lymphocytes (%), and lung consolidation in RMPP and explore their prediction results in the early stage of RMPP, which is important for early treatment.
METHODS
This systematic search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wangfang, and Cqvip, and the date was set until February 23, 2021. For the continuous variables, mean difference (MD) with 95% CI was adopted to evaluate CRP, LDH, ESR, D-dimer, neutrophils (%), lymphocytes (%), and the correlation between lung consolidation and RMPP.
RESULTS
20 studies including 5289 patients were included in the analysis, and the results showed that the CRP of the RMPP group (MD (95% CI): 22.29 (12.20, 32.38), < 0.001), LDH (MD (95% CI): 145.13 (78.62, 211.64), < 0.001), neutrophils (%) (MD (95% CI): 7.27 (0.31, 14.23), = 0.04), and D-dimer (MD (95% CI): 1.79 (-1.17, 4.74), = 0.24) was higher than that of the NRMPP group; the risk of lung consolidation in the RMPP group (OR (95% CI): 14.29 (4.52, 45.12), < 0.001) was higher than that in the NRMPP group, and there was no difference in ESR (MD (95% CI): 8.11 (-1.34, 17.56), = 0.09) and lymphocytes (%) (MD (95% CI): -6.27 (-12.81, 0.27), = 0.06) between the two groups.
CONCLUSION
So, the available evidence indicates that CRP, LDH, neutrophils (%), , and lung consolidation are predictive factors for RMPP.
Topics: Blood Sedimentation; C-Reactive Protein; Child; Humans; L-Lactate Dehydrogenase; Mycoplasma pneumoniae; Pneumonia, Mycoplasma
PubMed: 35795531
DOI: 10.1155/2022/9227838 -
The Journal of Antimicrobial... Aug 2022To determine the prevalence of resistance to macrolides in Mycoplasma pneumoniae worldwide. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To determine the prevalence of resistance to macrolides in Mycoplasma pneumoniae worldwide.
METHODS
Prior to 12 December 2020, PubMed, Web of Science, Scopus and Embase databases were searched for epidemiological studies of M. pneumoniae resistance. Two reviewers independently extracted data from included studies. The extracted data include sampling population, total sampling number, the number of resistant strains and the molecular subtype of resistant strains. The estimate of resistance prevalence was calculated using the random-effects model.
RESULTS
A total of 17 873 strains were obtained from five continents and reported in 98 investigations between 2000 and 2020, with 8836 strains characterized as macrolide resistant. In summary, macrolide-resistant M. pneumoniae was most common in Asia (63% [95% CI 56, 69]). In Europe, North America, South America and Oceania, the prevalence was 3% [2, 7], 8.6% [6, 11], 0% and 3.3%, respectively. Over the last 20 years, the prevalence of macrolide-resistant M. pneumoniae has remained high in China (81% [73, 87]), with a significant increasing trend in South Korea (4% [1, 9] to 78% [49, 93], P < 0.0001). Furthermore, a point mutation at 2063 from A to G was mostly related to M. pneumoniae macrolide resistance. In terms of clinical outcomes, longer cough (mean difference [MD]: 2.93 [0.26, 5.60]) and febrile days (MD: 1.52 [1.12, 1.92]), and prolonged hospital stays (MD: 0.76 [0.05, 1.46]) might be induced by macrolide-resistant M. pneumoniae pneumonia.
CONCLUSIONS
The incidence of macrolide-resistant M. pneumoniae varies globally, with eastern Asia having a greater degree of resistance. However, attention is also required in other areas, and antibiotic alternatives should be considered for treatment in high-prevalence countries.
Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Macrolides; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Prevalence; RNA, Ribosomal, 23S
PubMed: 35678262
DOI: 10.1093/jac/dkac170 -
The Journal of Antimicrobial... Jul 2022Limited antimicrobial resistance (AMR) surveillance coupled with syndromic management of sexually transmitted infections (STIs) in sub-Saharan Africa (SSA) could be...
OBJECTIVES
Limited antimicrobial resistance (AMR) surveillance coupled with syndromic management of sexually transmitted infections (STIs) in sub-Saharan Africa (SSA) could be contributing to an increase in AMR in the region. This systematic review aimed to synthesize data on the prevalence of AMR in common STIs in SSA and identify some research gaps that exist.
METHODS
We searched three electronic databases for studies published between 1 January 2000 and 26 May 2020. We screened the titles and abstracts for studies that potentially contained data on AMR in SSA. Then we reviewed the full text of these studies to identify articles that reported data on the prevalence of AMR in Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in SSA. We summarized the data using a narrative synthesis.
RESULTS
The 40 included studies reported on AMR data from 7961 N. gonorrhoeae isolates from 15 countries in SSA and 350 M. genitalium specimens from South Africa. All four SSA regions reported very high rates of ciprofloxacin, tetracycline and penicillin resistance in N. gonorrhoeae. Resistance to cefixime or ceftriaxone was observed in all regions except West Africa. Azithromycin resistance, recommended as part of dual therapy with an extended-spectrum cephalosporin for gonorrhoea, was reported in all the regions. Both macrolide and fluoroquinolone-associated resistance were reported in M. genitalium in South Africa. Studies investigating AMR in C. trachomatis and T. vaginalis were not identified.
CONCLUSIONS
There is a need to strengthen AMR surveillance in SSA for prompt investigation and notification of drug resistance in STIs.
Topics: Anti-Bacterial Agents; Chlamydia trachomatis; Drug Resistance, Bacterial; Gonorrhea; Humans; Mycoplasma Infections; Mycoplasma genitalium; Neisseria gonorrhoeae; Prevalence; Sexually Transmitted Diseases; South Africa
PubMed: 35578892
DOI: 10.1093/jac/dkac159 -
Sexually Transmitted Infections May 2022To examine associations between infection during pregnancy and adverse outcomes. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To examine associations between infection during pregnancy and adverse outcomes.
METHODS
We did a systematic review of observational studies. We searched Medline, EMBASE, the Cochrane Library and CINAHL up to 11 August 2021. Studies were included if they compared preterm birth, spontaneous abortion, premature rupture of membranes, low birth weight or perinatal death between women with and without . Two reviewers independently assessed articles for inclusion and extracted data. We used random-effects meta-analysis to estimate summary ORs and adjusted ORs, with 95% CIs, where appropriate. Risk of bias was assessed using established checklists.
RESULTS
We identified 116 records and included 10 studies. Women with were more likely to experience preterm birth in univariable analyses (summary unadjusted OR 1.91, 95% CI 1.29 to 2.81, I=0%, 7 studies). The combined adjusted OR was 2.34 (95% CI 1.17 to 4.71, I=0%, 2 studies). For spontaneous abortion, the summary unadjusted OR was 1.00 (95% CI 0.53 to 1.89, I=0%, 6 studies). The adjusted OR in one case-control study was 0.9 (95% CI 0.2 to 3.8). Unadjusted ORs for premature rupture of membranes were 7.62 (95% CI 0.40 to 145.86, 1 study) and for low birth weight 1.07 (95% CI 0.02 to 10.39, 1 study). For perinatal death, the unadjusted OR was 1.07 (95% CI 0.49 to 2.36) in one case-control and 38.42 (95% CI 1.45 to 1021.43) in one cohort study. These two ORs were not combined, owing to heterogeneity. The greatest risk of bias was the failure in most studies to control for confounding.
CONCLUSION
might be associated with an increased risk of preterm birth. Further prospective studies, with adequate control for confounding, are needed to understand the role of in adverse pregnancy outcomes. There is insufficient evidence to indicate routine testing and treatment of asymptomatic in pregnancy.
PROSPERO REGISTRATION NUMBER
CRD42016050962.
Topics: Abortion, Spontaneous; Case-Control Studies; Cohort Studies; Female; Humans; Infant, Newborn; Mycoplasma Infections; Mycoplasma genitalium; Perinatal Death; Pregnancy; Pregnancy Outcome; Premature Birth; Prospective Studies
PubMed: 35351816
DOI: 10.1136/sextrans-2021-055352